Сердечно-сосудистая патология и COVID-19: кратко о главном

Недогода С.В. Сердечно-сосудистая патология и COVID-19: кратко о главном. Consilium Medicum. 2020 (22); 5: 19–21. DOI: 10.26442/20751753.2020.5.200157

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Nedogoda S.V. Cardiovascular pathology and COVID-19: briefly on the main. Consilium Medicum. 2020 (22); 5: 19–21. DOI: 10.26442/20751753.2020.5.200157

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Аннотация

В ситуации пандемии COVID-19 особую группу риска составляют пациенты с сердечно-сосудистыми заболеваниями (ССЗ), которые широко распространены в популяции. Сочетание COVID-19 и ССЗ создает дополнительные сложности в диагностике, определении тактики терапии, порядке маршрутизации пациентов. Ситуация осложняется дефицитом информации, зачастую противоречивыми данными и крайне высокой важностью решения ряда вопросов для клинической практики. Настоящий обзор посвящен наиболее важным аспектам, касающимся сочетания ССЗ и COVID-19. Рассмотрены механизмы патологического влияния COVID-19 на сердечно-сосудистую систему, эпидемиологические аспекты сочетания данных патологий в разрезе влияния на смертность пациентов, влияние коморбидной патологии на прогноз пациентов с COVID-19 в сравнении с другими респираторными вирусными заболеваниями, патоморфологические особенности изменения тканей при COVID-19, а также побочные эффекты, которые могут возникать со стороны сердечно-сосудистой системы при использовании препаратов для лечения пациентов с COVID-19. Помимо этого, обсуждены безопасность и целесообразность терапии статинами, ингибиторами ангиотензинпревращающего фермента, блокаторами рецепторов ангиотензина II или другими блокаторами ренин-ангиотензиновой системы на исходы у пациентов с COVID-19.

Ключевые слова: сердечно-сосудистые заболевания, COVID-19, респираторная вирусная инфекция, ингибиторы ренин-ангиотензин-альдостероновой системы, препараты для лечения COVID-19, патологоанатомическое исследование.

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In the COVID-19 pandemic situation, patients with cardiovascular disease (CVD), which are prevalent in the population, form a special risk group. The combination of COVID-19 and CVD provides additional challenges for the diagnosis, choosing treatment tactics and routing of patients. The situation is complicated by a lack of information, often conflicting data and the extremely importance of resolving a number of issues for clinical practice. This review focuses on the most important aspects of the combination of CVD and COVID-19. The mechanisms of the pathological effect of COVID-19 on the cardiovascular system, the epidemiological aspects of combining these pathologies in terms of the effect on patient mortality, the effect of comorbid pathology on the prognosis of patients with COVID-19 in comparison with other respiratory viral diseases, the pathomorphological features of tissue changes with COVID 19, as well as side effects that may occur on the part of the cardiovascular system when using drugs to treat patients with COVID-19. In addition, the safety and feasibility of treatment with statins, ACE inhibitors, angiotensin II receptor blockers, or other renin-angiotensin system blockers for outcomes in patients with COVID-19 were discussed.

Key words: cardiovascular diseases, COVID-19, respiratory viral infection, inhibitors of the renin-angiotensin-aldosterone system, drugs for the treatment of COVID-19, pathoanatomical study.

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Список литературы

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1. Materialy po diagnostike i lecheniiu patsientov s serdechno-sosudistymi zabolevaniiami v usloviiakh pandemii COVID-19. https://scardio.ru/materialy_po_diagnostike__i_lecheniyu_pacientov__s_serdechnososudistymi__zaboleva... (in Russian).
2. Kang Y et al. Cardiovascular manifestations and treatment considerations in covid-19. Heart 2020.
3. Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis 2016; 49: 129–33.
4. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19). China, 2020. China CDC Weekly 2020; 2: 113–22.
5. Chan JWM et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax 2003; 58 (8): 686–9.
6. Mertz D et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ 2013; 347: f5061.
7. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance
8. Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr 2020.
9. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020; 1.
10. Zhou F et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020.
11. Wang D et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11): 1061–9.
12. Yao XH et al. A pathological report of three COVID-19 cases by minimally invasive autopsies. Zhonghua bing li xue za zhi. 2020; 49: E009.
13. Xu Z et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8 (4): 420–2.
14. Tian S et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Modern Pathology 2020; p. 1–8.
15. Fox SE et al. Pulmonary and cardiac pathology in Covid-19: the first autopsy series from New Orleans. Med Rxiv 2020.
16. Ng D. L. et al. Clinicopathologic, immunohistochemical, and ultrastructural findings of a fatal case of Middle East respiratory syndrome coronavirus infection in the United Arab Emirates, April 2014. Am J Pathol 2016; 186 (3): 652–8.
17. Alsaad KO et al. Histopathology of Middle East respiratory syndrome coronovirus (MERS‐CoV) infection – clinicopathological and ultrastructural study. Histopathology 2018; 72 (3): 516–24.
18. Lang ZW et al. A clinicopathological study of three cases of severe acute respiratory syndrome (SARS). Pathology 2003; 35 (6): 526–31.
19. Ding Y et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol 2003; 200 (3): 282–9.
20. Farcas GA et al. Fatal severe acute respiratory syndrome is associated with multiorgan involvement by coronavirus. J Infect Dis 2005; 191 (2): 193–7.
21. Mehra MR et al. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med 2020.

Авторы

С.В. Недогода*

ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава России, Волгоград, Россия
*nedogodasv@rambler.ru

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Sergei V. Nedogoda*

Volgograd State Medical University, Volgograd, Russia
*nedogodasv@rambler.ru

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